Children with autism

Autism Spectrum Disorder (ASD)

Autism is a pervasive developmental disorder and affects individuals to varying degrees. Individuals with ASD encounter impairments in their social interaction and communication skills. They engage in repetitive stereotyped behavior, activities, and interests (Reschke-Hernandez, 2011).

Early music therapists worked with children with autism in psychiatric hospitals, institutions, and public schools. The incorporation of music therapy into autism treatment came about as a result of a shift toward holistic treatment of psychiatric disorders seen in the 1940s. These efforts were funded by the government, allowing for psychiatric hospitals to employ music therapists, although volunteer music therapists also commonly participated in treatment (Reschke-Hernandez, 2011).

1950s and 1960s

With the formation of the National Association for Music Therapy (NAMT) in 1950, music therapists adapted music making activities to achieve various goals in autism treatment. One of the goals of the NAMT was to standardize protocol for music therapy treatment, and this certainly applied to the use of music therapy in the treatment of autism. The NAMT suggested the mainstreaming of children with autism with children developing in a regular fashion in music classrooms (Reschke-Hernandez, 2011).

A music class in which children with Autism are mainstreamed with their non-Autistic peers

Much of music therapy with autism literature during this time related to autistic children’s attraction to music and unusual musical skills and talents, Sherwin (1953) noted that children with autism often displayed a:

1. Strong interest in music

2. Tendency to sing differently from average children

3. Unusual ability to accurately reproduce familiar musical sounds or pieces of music

(Sherwin, 1953).

Nordoff and Robins and the Creative Music Therapy technique

Nordoff and Robins were pioneers in improvisational music therapy for children with autism. They believed children with autism saw music as a non-threatening medium, allowing for them to become engaged in the experience of music making easily. Together they developed Creative Music Therapy technique for children with autism. This technique used of child-directed techniques to help establish rapport between patients and therapists. Creative Music Therapy addresses behavior challenges through improvisation as a medium of self-expression. This allows for exploration of sensory sensitivities, like uncomfortableness with loud noises. Speech dynamics, rhythm, singing, dance, movement are all used to address attention, body awareness, social skills, communication (Reschke-Hernandez, 2011). In an article in the British Journal of Music Therapy Alvin says that establishing communication is the primary goal of music therapy with autistic children (Alvin, 1969).

Addressing criticisms of music therapy for children with autism

In the 1950s, music therapy for children with autism focused mostly on the unusual musical abilities of these children. Music therapy was recognized as having value, but not much research was present to support this (Reschke-Hernandez, 2011).

To address this issue, in 1969 Stevens and Clark published the first experimental study on the effects of music therapy on children with autism. Published in the Journal of Music Therapy, “Music therapy in the treatment of autistic children” was a study of 5- 7 year old boys with Autism. It found music therapy to be beneficial to these children, as shown by Ruttenberg’s Autism Scale. The study only included five participants because Autism was not widely diagnosed until later (Stevens & Clark, 1969).

Music therapists started to recognize the need for establishing goals of music therapy for children with autism by the end of the 1960s (Reschke-Hernandez, 2011).

Legislation in the 1980s and effects

The Education for All Handicapped Children Act, Public Law 94-142 provided free,

Public Law 94-142 allowed for Autistic children to receive a public school education

appropriate public education for all children with disabilities. This law was revised in 1990, qualifying children with autism under this law. In the 1980s, a new public law led to use of interdisciplinary model for success in treating children with autism. Thaut wrote a protocol for treating autistic children with music therapy. He looked at diagnostic criteria for autism and related music therapy to the diagnosis. Standards were established for documenting music therapy sessions (Reschke-Hernandez, 2011).

1990s

In 1990, many new opportunities for music therapy jobs and research because of amendment of Public Law 94-142. The law was renamed the Individuals with Disabilities Education Act, and the list of conditions was expanded to include autism. Treatment techniques now focused more on therapeutic approaches originating in psychology and special education (Reschke-Hernandez, 2011).

The TEACCH (Treatment in Education of Autistic and Related Communication Handicapped Children) method was applied to music therapy. To do this, music therapists:

-Created individualized activity schedules for each child.

-Incorporated the alternation of preferred and non-preferred activities to help decrease behavioral problems during sessions.

-Used music as a transition technique when moving from one activity to another.

(Reschke-Hernandez, 2011).

The United Way, a provider of funds for music therapy programs for children with Autism, explained the importance of measuring and reporting outcomes

In 1993, the Government Performance and Results Act made it necessary for all federal programs to start clearly identifying their goals and measuring their outcomes. It can be difficult to measure outcomes in a quantifiable way for music therapy in children with Autism, since they could easily be defined as “benefits for people during or after their involvement with a program.” The United Way provides funding for many organizations, including music therapy programs in children with Autism. In 1996, the United Way explained the importance of measuring and reporting outcomes, saying that it shows whether a program actually makes a difference, and helps the program to improve. Before the year 2000, the annual reports of music therapists stated demographic information such as the total number of clients they served, age, gender, ethnicity, and zip-code, rather than an outcomes-based assessment (Kaplan, 2005).

Some research continued to focus on symptoms of autism that are not necessarily related to education, such as sensory perception issues. Music therapists began looking at different timbres and vibrations creating different behavioral responses in relation to sensory perception (Reschke-Hernandez,2011).

Twenty-first Century Developments

Public Law 94-142 was revised in 2004, mandating that the educational techniques used to treat disabled children be evidence based. Because of this, music therapists were pressured to improve the level of evidence to justify how they treat autism.

The American Music Therapy Association established the Music Therapy and Autism Task Force/Think Tank in 2007 with the goal of guiding the future of music therapy and autism. It focused on evidence based practice, clinical research models, assessment models (Reschke-Hernandez,2011).

In 2000, Thaut developed the Rational-Scientific Mediating Model (R-SMM) as a way to systematically conduct research in music therapy that is high quality with the goal of establishing theoretical foundations as well as procedures for intervention based on evidence. According to this model, music therapists try to see if a response to music can be generalized to a setting without music (Thaut, 2000). Lim (2009) applied R-SMM in paralleling perception of music to perception of speech and language.

Thaut also developed the Transformational Design Model (TDM) to get rid of music therapy that is not goal-driven. Goals are developed based on the assessment of the client, and then translated into therapeutic exercises that are not musical. The music therapist then translates this into a music therapy application (Thaut, 2000). Brownwell (2002) applied the TDM process to a study of social stories that were musically adapted. Brownwell first assessed the needs of the client, and then found that social stories were an effective nonmusical therapeutic exercise. Lastly, Brownwell used prescriptive songs to apply this to music therapy (Brownwell, 2002)

Music therapists tailored programs for children with Autism to address the diagnostic criteria in the DSM-IV

The goals of music therapy in autism mirrored DSM-IV criteria for autism. The DSM-IV focuses on social behavior and communication in describing autism. Because of this music therapy shifted focus to social skills, with communication a second focus. Sensory issues are not the current issue of focus in research (Reschke-Hernandez, 2011). In accordance with the DSM-IV criteria, the Social Communication, Emotional Regulation, and Transactional Support (SCERTS) model of curriculum was developed in 2003 by B. M. Prizant. The goal if this model is to identify treatment goals and assess their outcomes. The model is to be used by an interdisciplinary team of doctors, therapists, and other practitioners involved with treatment for Autism Spectrum Disorders (DeLoach Walworth, 2007).

It is pertinent that music therapists become educated according to the SCERTS model for three reasons. First of all, the SCERTS model makes experimental research easier, as it provides a uniformed way of assessing goals and outcomes allows for multiple site studies to be done. With more information, we can make advances in the field and increase knowledge at a much faster rate. Secondly, funding for music therapy interventions for children with ASD has been eliminated in many states because of a lack of research based evidence. Since the SCERTS model makes it easier to conduct studies, music therapists have the opportunity to prove the effectiveness of their treatments. Thirdly, since the SCERTS model is used by an interdisciplinary team, it allows for music therapists to better communicate with the other individuals involved with the Autistic child’s treatment plan (DeLoach Walworth, 2007).

Recent Studies

Recent studies in music therapy for children with ASD are focused on improving emotional understanding, a crucial part of social interaction. Since repetition is an important element in the life of a person with Autism, treatment interventions that are repeated in a predictable pattern are most effective. Therefore, most twenty-first century studies of music therapy and children with ASD incorporate repeated exposure to music therapy. Katagiri (2009) conducted a study investigating the effect of background music on teaching children with Autism how to better understand emotions. All of the children in the study showed significant improvements in their understanding of happiness, sadness, anger, and fear after listening to background music representing the specific emotion in question. The study suggests that listening to music may be a helpful resource for better understanding emotions for children with Autism (Katagiri, 2009).

It is also interesting to compare the effects of music therapy with other forms of therapy. In a 2010 study, Lim looked at speech production in children with Autism after receiving either music training or speech training. The results showed that all of the children benefited from both forms of therapy as demonstrated through improved verbal skills. However, the low-functioning children with Autism showed significantly larger improvements with music training than with speech training (Lim, 2010). Another study showed that speech production in children with Autism could be improved by incorporating music into ABA VB, or Applied Behavioral Analysis Verbal Behavior training (Lim & Draper, 2011).

Newest Developments in Treatment

The Music Hut is a playground designed to encourage outdoor exploration for children with and without Autism

Some intervention techniques that have recently developed and are currently evolving include family based therapy, prescriptive songs, music therapy tools to use outside of sessions, and the Music Hut, a musical playground to encourage outdoor play with other children (Reschke-Hernandez, 2011).

References

Alvin, J. (1969). Work with an autistic child. In British Society for Music Therapy (Ed.), Music therapy for autistic disability: A collection of articles on autism published in the British Journal of Music Therapy 1968-87, the Journal of British Music Therapy 1987-9, and conference papers of the BSMT 1960-92 (pp. 1-5). Hertfordshire, England: Editor.

Brownwell, M. D. (2002). Musically adapted social stories to modify behaviors in students with autism: Four case studies. Journal of Music Therapy, 39, 117-144.

DeLoach Walworth, D. (2007). The Use of Music Therapy within the SCERTS Model for Children with Autism Spectrum Disorder. Journal of Music Therapy, 44(1), 2-22.

Kaplan, R. S. (2005). An Analysis of Music Therapy Program Goals and Outcomes for Clients with Diagnoses on the Autism Spectrum. Journal of Music Therapy, 42(1), 2-9.

Katagiri, J. K. (2009). The Effect of Background Music and Song Texts on the Emotional Understanding of Children with Autism. Journal of Music Therapy, 46(1), 15-31.

Lim, H. A., & Draper, E. (2011). The Effects of Music Therapy Incorporated with Applied Behavior Analysis Verbal Approach for Children with Autism Disorder. Journal of Music Therapy, 48(4), 532-550.

Lim, H. A. (2010). Effect of “Developmental Speech and Language Training Through Music” on Speech Production in Children with Autism Spectrum Disorders. Journal of Music Therapy, 47(1), 2-28.

Lim, H. A. (2009). Use of music to improve speech production in children with autism spectrum disorders: Theoretical orientation. Music Therapy Perspectives, 27, 103-193.

Reschke-Hernandez, A. E. (2011). History of Music Therapy Treatment Interventions for Children with Autism. Journal of Music Therapy, 48(2), 169-207.